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Awareness of the more uncommon multiple sclerosis symptoms can lead to an earlier diagnosis and appropriate treatment. For instance, experiencing electrical shock sensations when bending the neck forward, known as Lhermitte’s sign, may indicate an attack on the cervical spinal cord. Likewise, excruciating bolts of pain across either side of the face, called trigeminal neuralgia, can be caused by a MS relapse. The MS hug, an unfriendly, squeezing sensation around the torso, can respond to muscle relaxants and nerve pain medications. Some MS symptoms, like tingling in legs, only surface when exercising or overheated (Uhthoff’s phenomenon).
Vertigo, a spinning sensation, can be a sign of MS, especially when lasting days and accompanied by other symptoms like gait imbalance, facial numbness and double vision. Brainstem attacks may also lead to swallowing issues and shaky vision. While MS bladder issues are commonly addressed, bowel problems, including constipation, urgency, incontinence and trouble evacuating, should not be overlooked. Overcoming stigma is essential to treat sexual dysfunction.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Mary Ann Picone MD, Medical Director, MS Center at Holy Name Medical Center, Teaneck, New Jersey
Bruce Hughes MD, Director of the Ruan Multiple Sclerosis Center, MercyOne, Des Moines, Iowa
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Prepare to be intrigued by the groundbreaking intersection of artificial intelligence (AI) and multiple sclerosis care! By combing through extensive databases, including genetic information and real patient records, AI can forecast with remarkable accuracy the likelihood of MS onset. In the near future, AI could even serve as a guiding light for clinicians and MS patients in selecting the most suitable disease-modifying therapies, armed with predictive algorithms tailored for each individual.
But the marvels of AI don’t stop there. In a recent study, AI detected an astonishing 93% of new and enlarging T2 brain lesions in MRI scans, far surpassing the 58% accuracy rate of routine radiology reads. Artificial intelligence is also making waves in drug development and early clinical trial design, accelerating the quest for innovative therapies to combat MS.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Tal Arbel PhD, Professor, Department of Electrical and Computer Engineering, McGill University, Montreal
Michael Barnett MBBS (Hons) FRACP PhD, Professor in Neurology, University of Sydney and Director of the MS Society Clinic & MS Clinical Trials Unit at the Brain and Mind Centre
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Living with multiple sclerosis isn't just about managing the condition itself, but often involves navigating a myriad of additional health concerns known as comorbidities. Individuals with MS face a higher risk of experiencing new relapses when dealing with comorbidities like high cholesterol or depression. Furthermore, autoimmune diseases such as psoriasis and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis are more prevalent among those with MS. There is even a heightened risk of bladder cancer.
Interaction of MS treatments and other common conditions like high blood pressure (hypertension), high cholesterol and diabetes are addressed. Experts share how immunotherapies used for other autoimmune diseases may benefit or actually worsen MS disease activity. Crucial information is shared on cancer treatment concerns in individuals with MS. Adopting healthy lifestyle behaviors is essential to minimize the development of these comorbidities.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Ruth Ann Marrie MD PhD, Professor of Medicine and Community Health Sciences at University of Manitoba, Canada
Mark Cascione, MS neurologist, South Tampa MS Center, USA.
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Sex hormones, such as estrogens and testosterone, affect each individual's journey living with multiple sclerosis. While both genders face equal MS risk before puberty and after menopause, women experience up to three times higher risk during their reproductive years. Pregnancy generally brings less relapses, potentially attributed to high estriol levels. However, navigating treatment decisions well while trying to conceive and after delivery requires finesse and expertise. Equip yourself with the latest women's health info regarding MS, covering topics from birth control and fertility treatments to menopause and osteoporosis.
Testosterone has important anti-inflammatory and neuroprotective benefits in multiple sclerosis. Nevertheless, men are at higher risk for disability progression then women. Declining testosterone levels over time (called andropause) and Y chromosome genes may tilt the scales towards disability. Listen to current testosterone research including potential remyelination benefits.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Maria Houtchens MD, founding director of the Women’s Health Program at the Brigham MS Center and Associate Professor of Harvard Medical School in Boston, USA
Jorge Correale MD, Head of Neuroimmunology and Demyelinating Diseases at the Dr. Raúl Carrea Institute of Neurological Research in Buenos Aires, Argentina
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In a paradigm-shifting discovery, researchers uncovered that B cells, not T cells, wield significant influence on orchestrating neurological damage in MS. Join UCSF Professor Dr. Stephen Hauser as he shares the remarkable odyssey from hurdles to triumphs of developing B cell monoclonal antibody treatment for multiple sclerosis. Disease impact, safety concerns and personalization of MS treatment of these medications including Ocrevus (ocrelizumab), Kesimpta (ofatumumab) and Briumvi (ublituximab) are highlighted.
Brain-penetrant BTK inhibitor therapies that may offer more direct targeting of B cells within the central nervous system, potentially unlocking new possibilities in treating progressive forms of MS. Professor Heinz Wiendl explores the connection between Epstein-Barr virus infection of B cells and the initiation and progression of MS including trials investigating strategies to target EBV-infected B cells. Pioneering approaches like CAR-T therapy and brain shuttle techniques provide optimism for the next generation of MS treatment.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Stephen Hauser MD, Professor of Neurology at the University of California, San Francisco (UCSF) and Director of the UCSF Weill Institute for Neurosciences
Heinz Wiendl MD, Professor of Neurology and Chair of the Department of Neurology at the University Hospital of Muenster in Germany
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Christine Ha, an award-winning blind chef and restauranteur, shares her experience grappling with neuromyelitis optica spectrum disorder (NMOSD). Facing relapses with the inability to walk and feed herself that challenged her independence, she leaned on the support from family and friends. As she lost her sight due to optic neuritis in both eyes, Ms. Ha had to embark on a journey of rediscovery in the kitchen, starting with the fundamentals. Winning MasterChef Season 3 marked a turning point, propelling her culinary career forward despite the obstacles posed by her disability.
NMOSD is an autoimmune disease in which an antibody attacks water channels on astrocyte cells in the optic nerves, spinal cord and sometimes the brain. Attacks or relapses can be devastating and incomplete recovery from attacks is typical. Like Ms. Ha, some people living with the condition can be misdiagnosed with multiple sclerosis. A blood test for the aquaporin-4 antibody is key to getting diagnosed correctly early. Since 2019, highly effective treatment options have been FDA-approved that reduce relapses by 77-94%.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Christine Ha, "The Blind Cook". Her first cookbook, Recipes from My Home Kitchen, was a New York Times best-seller. Ms. Ha’s first restaurant in Houston, The Blind Goat, was named a semi-finalist for 2020 Best New Restaurant in America by the James Beard Foundation. She was also named a James Beard finalist for Best Chef in Texas in 2022.
Michael Levy MD PhD, Associate Professor at Harvard Medical School and Director of the Neuroimmunology Clinic and Research Laboratory
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Wherever you are on your multiple sclerosis journey, there are many reasons to be optimistic about the future of mobility. Our experts, both holding doctorates in physical therapy, offer invaluable guidance on enhancing your walking abilities through targeted exercise and specialized therapy. Learn how to reduce the risk of falls, alleviate spasticity, and build endurance for a more active life.
Cutting-edge technology, from wearable electrical stimulation devices to incredible exoskeletons, are revolutionizing mobility for those living with MS. Discover how neuromodulation, in conjunction with physical therapy, can pave the way for new neural pathways. Virtual reality and anti-gravity treadmills are redefining therapy options for those people with advanced MS. Moreover, gain insights into conquering travel challenges, empowering individuals living with multiple sclerosis to venture out into the world.
Barry Singer MD, Director of The MS Innovations in Care, interviews Gretchen Hawley DPT, The MSing Link and Annie Morrow DPT, Director of the Stephen A. Orthwein Center.
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Health equity represents the pursuit of the highest level of well-being for all individuals, ensuring that every person, regardless of their background, enjoys a fair and just opportunity to achieve their optimal health.
Disparities exist within the multiple sclerosis community. It's a stark reality that Black individuals with MS face an increased risk of disability, while Black women are disproportionately affected by this condition compared to their White counterparts based on a Kaiser study. Additionally, Hispanic patients often contend with an earlier onset of MS, occurring 3-5 years before it typically manifests in White individuals. Both social determinants of health and genetic factors play significant roles in shaping outcomes for these communities. Strategies to enhance MS care in underserved communities include increasing the availability of healthcare providers, providing crucial translation services, and addressing biases both within the healthcare team and the communities they serve.
Rural MS patients experience unique challenges, often encountering barriers in accessing specialized care. Connecting lower-income patients to vital resources, including medications and MRI scans, is essential. Innovative approaches like telehealth and improved transportation options can bridge the gap for those with higher levels of disability. As an MS community, we can all advocate to ensure that everyone regardless of their circumstances receives the comprehensive care that they deserve.
Barrry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Lilyana Amezcua MD, Associate Professor of Neurology, University of Southern California. She spearheaded the collaborative research consortium Alliance for Research in Hispanic MS (ARHMS) and serves as principal investigator. Dr. Amezcua serves on numerous national and international committees including as an elected member to the NMSS National Medical Advisory Committee and NIH NINDS Health Disparities Strategic Steering Committee.
Jacqueline Rosenthal MD, MS neurologist at the Shepherd Center's Andrew C. Carlos Multiple Sclerosis Institute in Atlanta. Dr. Rosenthal completed her medical degree from Morehouse School of Medicine in Atlanta, neurology residency at Madigan Army Medical Center in Tacoma and neuroimmunology fellowship at Emory University School of Medicine.
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Navigating life with multiple sclerosis? Gain valuable insights from MS insiders! Stanford nurse practitioner Jong-Mi Lee reveals strategies for accessing MS centers and maximizing available resources. Acquire valuable tips on various topics including overcoming mobility challenges, managing workplace issues, and receiving quality care despite insurance obstacles.
Many inspiring and resilient individuals living with MS actively share their perspectives on social media platforms within the MS community. Dominic Shadbolt, a renowned UK MS patient advocate and founder of The MS Guide, highlights his personal favorites and provides essential advice for sifting through the wealth of online information.
Access reliable knowledge and support from global non-profit organizations. Dr. Jaime Imitola, esteemed MS neurologist and Associate Professor of Neurology at the University of Connecticut, offers practical approaches to surmount financial barriers and attain crucial MS treatments.
Podcast Host: Barry Singer MD, Director of The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis, USA
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Step into the powerful realm of MRI imaging, providing us with an unparalleled view of multiple sclerosis. Discover how acute inflammation becomes vivid with contrast, and how various MRI sequences unveil the past battles fought within your brain and spinal cord. We'll explore advances in techniques, revealing brain shrinkage, gray matter disease and myelin repair. Understand the impact of MS on brain processing efficiency during rest and specific tasks through functional MRI imaging. Crucial questions regarding where and how often to get MRI scans are addressed. Latest guidance on avoiding contrast for routine MRI monitoring in MS shared.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Christina Azevedo MD, Assistant Professor of Clinical Neurology at the University of Southern California
Robert Zivandinov MD, PhD, Director of the Buffalo Neuroimaging Analysis Center & Professor of Neurology at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, State University of New York.
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Dive into a deeper understanding of the role of inflammation in causing injury to the brain and spinal cord in multiple sclerosis. It’s a journey marked by ups and downs, where the adaptive immune system composed of lymphocytes (T and B cells) attack myelin and the innate immune system clears damaged myelin. An immune cell called microglia can create smoldering inflammation in MS that poses a threat of progressive disability.
Explore the arsenal of MS treatment strategies developed over the past 3 decades to either alter or suppress the immune system to reduce inflammation. Triumphs and limitations of our current MS therapies shared. Antioxidant research, diet and new therapeutics tackling smoldering inflammation bring newfound hope.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Klaus Schemierer MB BS, PhD, FRCP, Professor of Neurology at the Blizard Institute, Queen Mary University of London, and Consultant Neurologist at The Royal London Hospital, Barts Health NHS Trust.
Michael Kornberg MD, PhD, Assistant Professor of Neurology at John Hopkins.
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Yes, children can get multiple sclerosis.
Children ages 12 and up are more typically affected and rarely before age 8. Awareness is essential for prompt diagnosis and treatment of pediatric-onset MS (POMS). Accurate diagnosis of multiple sclerosis in children requires screening for other conditions like MOG antibody-associated disease (MOGAD). Risk factors associated with higher rates of developing MS in kids include Epstein-Barr virus infection, genetic susceptibility, pesticide exposure, smoking (and secondhand smoke), low vitamin D, obesity and diet high in saturated fats.
Multiple sclerosis in kids can be very active with frequent relapses and concerning MRI activity kids. Rapid use of highly effective treatment is important to preserve brain health including cognition. Completed and ongoing global pediatric trials are redefining care. Oral fingolimod, for example, reduced relapses by 82% compared to interferon beta-1a injections weekly. Thanks to treatment advancements, teens living with MS have a brighter future ahead of them.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews Brenda Banwell MD, Chief of the Division of Neurology at the Children's Hospital of Philadelphia (CHOP) and Emmanuelle Waubant MD, PhD, Professor of Neurology , University of California San Francisco and Director of the UCSF Regional Pediatric Multiple Sclerosis Center.
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Trying to confirm if you have multiple sclerosis can be a frustrating process. Dealing with a new diagnosis a MS can be overwhelming. Julian Gamboa and Dr. Jakai Nolan shed light on a positive path forward living with multiple sclerosis.
Julian Gamboa shares his first symptoms of multiple sclerosis including spinning sensation and double vision. He had substantial obstacles and setbacks in being diagnosed including a prolonged hospitalization. After being in a very low place, Julian rallied with the support of others including his family. He conveys how he eventually obtained superb MS care and utilizing his social media guru skills to help others being diagnosed with MS.
Dr. Jakai Nolan opens up about her own unique insights on being diagnosed with multiple sclerosis since she is both a neurologist specializing in multiple sclerosis and a person living with MS. As she shares her own personal story, she reviews key symptoms suggestive of MS and the importance of advocating for prompt evaluation to prevent a delay in diagnosis and treatment. Dr. Nolan covers treatment selection, mental health concerns and lifestyle modifications for someone recently diagnosed.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Julian Gamboa is the Social Media Director for Maximum Effort, supporting brands affiliated with Ryan Reynolds including Mint Mobile, Aviation Gin and Wrexham AFC. He was the former senior marketing and social media manager at Adweek. He serves on the Board of Directors of the Multiple Sclerosis Association of America.
Dr. Jakai Nolan is a neurologist specializing in multiple sclerosis in Villa Rica, Georgia and Endowed Neurology Chair for Tanner Medical Center. She received her undergraduate degree from Vanderbilt University, a Master's degree in Public Health at Emory University and her medical degree from Philadelphia College of Osteopathic Medicine, Georgia Campus. Dr. Nolan completed a MS fellowship at OhioHealth.
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Years before the first typical neurological symptoms of multiple sclerosis such as numbness or visual loss, individuals can have other symptoms that are often overlooked. This period of time is called the MS prodrome. During the prodrome phase, there is an increase in symptoms including skin, gastrointestinal and psychiatric issues. Research may lead to earlier detection of MS.
Sometimes brain spots or "lesions" typical of multiple sclerosis can be surprisingly found in people who get an MRI scan of the brain for unrelated reasons such as headaches or head trauma. If the person never had MS symptoms, it's called radiologically isolated syndrome (RIS). RIS risk factors that really increase the risk of a MS relapse include spinal cord lesions, oligoclonal bands in spinal fluid and new MRI lesions over time. Clinical trials for RIS treatment reviewed including recent positive results.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Helen Tremlett PhD, Professor in the Division of Neurology at the University of British Columbia and the Canada Research Chair in Neuroepidemiology and Multiple Sclerosis
Erin Longbrake MD PhD, an Associate Professor of Neurology at Yale School of Medicine and Director of Neuroimmunology Clinical Research
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Knowing which MS changes are significant enough to warrant speaking up can be hard. Relapses can occur every 1-2 years without treatment, but much less frequently on disease-modifying treatment. Distinguishing between an actual relapse, a pseudorelapse or just brief worsening of symptoms (Uhthoff’s phenomenon) explained. Options for relapses such as steroids, plasmapheresis and ACTH are reviewed. Importance of MRI monitoring addressed since most new MS lesions pop up on MRI scans without actual symptoms.
Slow progression of disability can be challenging to detect. Physical changes can include slower walking, worsening balance and more hand coordination problems. Cognitive worsening may be noticeable due to short-term memory loss, word-finding issues and multitasking challenges. Tools to improve monitoring for disease progression highlighted such as in-office testing, remote electronic monitoring and biomarker blood testing. Why multiple sclerosis disability can worsen without MRI change explained. Ways to better advocate for prompt care of worsening MS shared.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews Jacqueline Nicholas MD, System Chief of Neuroimmunology & Multiple Sclerosis at the OhioHealth Multiple Sclerosis Center and James Bowen MD, Medical Director of the Multiple Sclerosis Center at Swedish Neuroscience Institute in Seattle.
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With over 20 options, what is the best multiple sclerosis treatment for me? Selecting an appropriate disease-modifying therapy (DMT) needs to consider your risk of worsening disability over time. Your age, sex and race can affect your prognosis and can influence the power of treatment chosen. Details about your early relapses and MRI activity are very important for treatment decisions.
Treatment selection should also consider responsiveness to vaccines, family planning and other medical problems (another autoimmune disease or cancer). For each individual living with multiple sclerosis, balancing power of treatment against serious risks of treatment needs to be considered. The future of personalizing care to better pick the right medication shared.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews Celia Oreja-Guevara MD PhD, Vice Chair of Neurology & Head of the Multiple Sclerosis Center, University Hospital, San Carlos, Madrid, Spain & John Foley MD, Director, Rocky Mountain MS Clinic, Salt Lake City, Utah
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Digital technology has transformed our lives. For people living with multiple sclerosis, electronic health opens a new world. Biosensors in our smartphones and wearable devices can monitor physical activity levels and sleep and may detect MS disease changes faster than that next neurologist appointment. New apps can help people with MS manage and track their disease including gaming to assess cognition.
Digital health is becoming an indispensable part of in-office and virtual patient appointments. Privacy concerns with electronic healthcare addressed. Treatment decisions facing both doctors and patients are getting increasingly complex. New artificial intelligence technology may soon help personalize treatment and predict treatment response using a concept of a digital twin.
Barry Singer MD, Director of The MS Center for Innovations in Care interviews:
Jennifer Graves MD PhD is an Associate Professor at UC San Diego School of Medicine and serves as Director of the UC San Diego Neuroimmunology Research Program. Dr. Graves completed a fellowship in neuro-ophthalmology and residency in neurology at the University of Pennsylvania Perelman School of Medicine. She earned her medical degree and PhD in molecular biophysics from University of Texas Southwestern Medical School. She also holds a master's degree in epidemiology and biostatistics from UC San Francisco.
Tjalf Ziemssen MD PhD is founder and director of the MS Center in Dresden, Germany where he did his neurology training. Professor Ziemssen is also Director of the Center of Clinical Neuroscience and the neuroimmunological lab at the Carl Gustav Carus University Hospital in Dresden. He completed his medical training and doctoral thesis at the University of Bochum. He also was a research fellow at the Max Planck Institute of Neurobiology.
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Multiple sclerosis frequently causes visual impairment. 70% of people living with the disease can develop optic neuritis at some point and often the first sign of MS. The symptoms, medical evaluation, treatment and prognosis of optic neuritis are conveyed. Besides multiple sclerosis, other causes are discussed including MOG antibody-associated disease (MOGAD) and neuromyelitis (NMO).
Double vision and shaky (or jumpy) vision are other concerning visual symptoms for people with MS. The reason for these eye movement abnormalities and detailed treatment options are covered. Experts share the latest advancements in vision research for those living with multiple sclerosis. Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Dr. Anneke van der Walt is an Associate Professor of Neurology at Monash University in Melbourne, Australia. She is the head of the MS and Neuro-ophthalmology Research Group. She completed her undergraduate work in South Africa and completed her neurology training and PhD at the University of Melbourne. She is also the Chief Operating Officer of MSBase Foundation.
Dr. Tariq Bhatti is a neuro-ophthalmologist currently at Kaiser Permanente in Northern California. He completed his neuro-ophthalmology fellowship at Emory. Dr. Bhatti was most recently a Professor of Ophthalmology and Neurology at Mayo Clinic and previously Chief of Neuro-ophthalmology at Duke University.
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Rapid recent advancements have led to blood tests (biomarkers) to track multiple sclerosis disease activity. A biomarker is something that can be measured to check normal functioning or the impact of a disease. Blood biomarkers are common in medicine to measure response to therapy such as measuring hemoglobin A1c levels for diabetic control and cholesterol levels for high cholesterol treatment.
Injury to nerve cells (neurons) and other cells in the brain and spinal cord can be measured in the blood by checking levels of proteins such as neurofilament light chains (NfL) and glial fibrillary acid protein (GFAP). One panel of these blood markers helps identify people with multiple sclerosis with current active MRI scans. The future of MS biomarkers involves blood tests to diagnose multiple sclerosis, select the best treatment for an individual, and measure treatment response.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:
Tanuja Chitnis MD, Professor of Neurology at Harvard Medical School, is the Director of both MGB Pediatric Multiple Sclerosis Center and Translational Neuroimmunology Research Center at Brigham and Women’s Hospital. She is also Co-Director of the Brigham Multiple Sclerosis Center at Brigham and Women’s Hospital.
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Our immune systems become less robust as we age. With an autoimmune disease such as multiple sclerosis, a weakened immune system can lead to less relapses and active MRI lesions. However, many people living with multiple sclerosis develop progressive disease with worsening physical and cognitive disability as they age. Strategies to live better with MS as one grows older are shared.
The vast majority of treatments for multiple sclerosis have been studied in people 55 years of age or younger. However, 46% of people living with MS are older than age 55. New studies are answering important questions about MS treatment in older patients. At what age can treatment safely be stopped without risk of relapse or worsening disability? Safety concerns such as serious infections, cancer risk, and immunization responsiveness in older MS patients on immunosuppressive treatments are addressed.
Barry Singer MD, director of The MS Center for Innovations in Care, interviews:
Bianca Weinstock-Guttman MD, Professor of Neurology at the Jacobs School of Medicine & Biomedical Sciences in Buffalo, New York, and the Director of the Jacobs MS Center for Treatment and Research.
John Corboy MD, Professor of Neurology at the University of Colorado Denver School of Medicine and Co-Director of the Rocky Mountain MS Center.
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